Addressing Biopsychosocial Factors Is One Way Workers’ Comp Can Intervene Directly in an Injured Worker’s Recovery

COVID’s aftermath has revealed — and worsened — a hidden epidemic of workplace mental distress. Combating it will require holistic biopsychosocial solutions and earlier intervention.
By: | September 20, 2023
A young woman sits in an office to receive biopsychosocial treatment

By now, the widespread public health and economic problems triggered by the COVID-19 pandemic are well documented. Lost in the shuffle, though, are its subtler effects — those underlying vulnerabilities that have perhaps always existed, but only surfaced in the aftermath of a public health emergency that taxed our collective resiliency to the breaking point.

The previously hidden dangers now coming to the fore — like untenable levels of depression, anxiety and social distrust — are system-wide, and solving them requires an equally holistic approach.

In a session at this year’s National Comp entitled “Help Workers Reclaim Their Resilience: A Holistic, Whole-Person Approach,” moderator Mark I. Weinberger, president & CEO of the IMA Group, introduced Darrell Bruga, CEO of Empatha Care Management and a clinician specializing in biopsychosocial rehabilitation models. Noreen Olson, senior claims manager for Starbucks and a risk manager responsible for 175,000 employees, was unable to attend; in her stead, Bruga presented data and Starbucks case studies relating to on-the-job injury and recovery, illuminating new approaches to mitigate against these pernicious problems.

A Rising Tide of Mental Distress

One of the most significant lingering problems brought on by the stress of the pandemic is its long-term effect on mental wellbeing.

Since the pandemic, Bruga explained, we’ve seen a tenfold increase in anxiety and a doubling of rates of depression.

In the Starbucks workforce, Olson’s data showed, this has manifested as increased emotional fragility and distress, especially among its youngest members, as well as increased anger and distrust.

This means that more of the company’s workers have behavioral, emotional and mental health conditions at the time of their injuries, biopsychosocial factors that can complicate their return to work.

Portrait of Noreen Olson

Noreen Olson, senior claims manager, Starbucks

“It is also important to note that Starbucks actively recruits among underemployed and/or disenfranchised demographics,” Olson noted in a statement to Risk & Insurance prior to the session. “These partners may also have a history of trauma separate from surviving the pandemic that further impacts how they see and navigate their world.”

Alongside these mental health issues is a growing tide of social distrust. As more people get their news from questionable sources, misinformation makes it more difficult to build the kind of relationships it takes to communicate effectively between the injured worker, company management, claims examiners and care providers, and even small hiccups in a recovery journey can result in major setbacks.

Applying a Biopsychosocial Approach Earlier

As Olson’s case studies demonstrated, an emphasis on building better communication, transparency and trust has helped her achieve earlier intervention over time, including in the types of behavioral or mental health issues that can affect claim outcomes.

These interventions can focus on biopsychosocial factors — not just the physical impairments from an injury.

As Bruga explained, Official Disability Guidelines and ACOEM Guidelines have for years recommended the use of a biopsychosocial approach for at-risk individuals early in a claim, but the workers’ comp industry has been slow to adopt these treatments (perhaps out of concern that it will lead to an increase in psych claims).

He further pointed out that older models focused on physical symptoms don’t correlate well with observed return-to-work outcomes. In fact, four psychosocial factors are better determinants of work disability: catastrophic thinking, symptom exacerbation fears, perceived injustice and disability beliefs.

These four factors have been escalating post-pandemic, stemming both directly from it and from other social factors like the rise of social media and a more polarized media landscape. All of this is only exacerbated by pandemic-induced provider staffing shortages and burnout, which leave providers with even less time to spend with patients.

Still, Bruga said, screening for these factors and intervening with behavioral therapy programs can improve outcomes. 

“Research tells us that pain and symptoms of mental health only account for about 10% of the reason why people don’t return to work,” Bruga said. “What we have found, though, is that psychosocial risk factors account for about 30 to 40% of the reasons why people are not returning to work. That’s not all of the reasons — there’s certainly a multitude of reasons why people get stuck and aren’t able to transition back to work. But that’s certainly an area that we should really look at.”

Bruga also pointed out that, while many of the factors that affect a workers’ recovery are beyond the control of workers’ comp, biopsychosocial factors that prolong recovery, including things like fear and catastrophic thinking, can in fact be treated and changed.

First, Bruga said, work disability must be understood as a distinct category, quite separate from the physical injury per se.

“[Work injury] is a separate condition from the medical condition,” he said. “There are some states that have made advances to this direction, that work disability is a diagnosis … We oftentimes talk about coping skills, reducing distress, reducing symptoms. That’s important, but you also want a solution that will focus on the work disability itself.”

One way to address this, he said, was to get workers to advance their abilities outside of the work milieu, helping them to recognize the full extent of their recovery a “belief change” intervention.

Portrait of Darrell Bruga

Darrell Bruga, CEO, Empatha Care Management

“When people get injured, they tend to get sedentary pretty quickly,” Bruga said. “They don’t get out of the house. They’re not participating in life with their husband or wife as well as they once did there. They don’t go see friends.

“If we think about work disability that way, then it would make sense that one of the best ways to return people back to work would be to reengage them back into those meaningful life roles that they’ve discontinued. And that’s precisely what we’ve been doing. With these interventions, we’re able to reengage them into those life roles. We plan new activities, and we get them to behave in a way that’s incompatible with work disability. And you start to see a shift, and people feel like they can go back to work.”

Bruga also emphasized that identifying an injured worker’s need for additional psychosocial coaching or behavioral cognitive therapy does not necessarily lead to a psych claim; these treatments can be provided under the Health and Behavioral Codes of the initial claim, such as a shoulder or back injury.

“There are vendors now within workers’ comp that understand how to code,” Bruga said, “so if you have a back problem, there are health and behavior codes you can use that just work off the medical diagnosis, if you have a physical diagnosis.”

He explained, “This is a worker-centric approach, and that’s really what workers comp is intended to do: to get people back to work, to help them and their recovery as quickly as possible.” &

David Agnew is an associate editor at Risk & Insurance®. He can be reached at [email protected].

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